A Rare Complication of Acute Otitis Media: Brain Abscess Case Report

Öz

ABSTRACT While meningitis is defined as inflammation of the pia and arachnoid membranes, brain abscess is defined as suppurative infection occurring in the parenchymal tissue of the brain. The source of brain abscesses are usually middle ear infections, mastoiditis, frontal and nasal sinusitis. A 69-year-old female patient was brought to the emergency room by her relatives with a complaint of confusion. It was learned that the patient had pain in his right ear for 3 days and antibiotic treatment was started the day before due to infection in the eardrum. Infective blood parameters were high. A lesion containing air density was observed in the patient's brain CT scan in the right temporal fossa. Upon this radiological finding, a contrast-enhanced brain MRI was performed and a lesion containing air-fluid leveling was detected in the right temporal lobe. A tube was inserted into the eardrum of the patient by the ear, nose and throat department. He was transferred to intensive care for follow-up and treatment after the procedure. Acute otitis media is an infection that can progress with intracranial complications if not treated properly and if left untreated. It should not be forgotten that meningitis and brain abscess may also occur in a patient with altered consciousness diagnosed with acute otitis media.

Anahtar Kelimeler

• Acute otitis media
• Emergency department
• Brain abscess

Akut Otitis Medianın Nadir Bir Komplikasyonu: Beyin Apsesi Olgu Sunumu

Öz

Menenjit pia ve araknoid zarlarının iltihaplanması olarak tanımlanırken, beyin apsesi beynin parankimal dokusunda meydana gelen süpüratif enfeksiyon olarak tanımlanır. Beyin apselerinin kaynağı genellikle orta kulak enfeksiyonları, mastoidit, frontal ve nazal sinüzitlerdir. 69 yaş kadın hasta yakınları tarafından bilinç bulanıklığı şikayeti ile acil servise getirildi. Hastanın 3 gündür sağ kulağında ağrısı olduğu ve bir gün önce kulak zarında enfeksiyon nedeniyle antibiyotik tedavisi başlandığı öğrenildi. Kan parametrelerinde enfektif parametreleri yüksek idi. Hastaya çekilen Beyin BT’de sağ temporal fossada hava dansitesi içeren lezyon izlendi. Bu radyolojik bulgu üzerine kontrastlı beyin MR çekildi ve sağ temporal lobda hava-sıvı seviyelenmesi içeren lezyon tespit edildi. Hastaya kulak burun boğaz branşı tarafından kulak zarına tüp takıldı. İşlem sonrası takip ve tedavisi için yoğun bakıma devredildi. Akut otitis media uygun tedavi edilmeyip geç kalındığında intrakraniyal komplikasyonlarla seyredebilen bir enfeksiyondur. Akut otitis media tanısı almış bilinç değişikliği olan hastada menenjit ve beyin apsesinin de olabileceği unutulmamalıdır.

Anahtar Kelimeler

• Akut otitis media
• Acil servis
• Beyin Apsesi

Kaynakça

1. 1. Brook I. Microbiology and choice of antimicrobial therapyfor acute sinusitis complicated by subperiosteal abscess in children. Int J Pediatr Otorhinolaryngol 2016; 84: 21-6.
2. 2. Rajasekaran V, Mohanraj L, Prabhu ND. Silent otitis media with multiple intracranial complications. BMJ Case Rep 2024;17(12):e262319.
3. 3. Rubini A, Ronzani G, D’Alessandro E, Marchioni D. Management of otogenic meningitis: A proposal for practical guidelines from a multicenter experience with a systematic review. J Clin Med 2024; 13(18): 5509.
4. 4. Dongol K, Rayamajhi P, Gurung U. Complications of acute and chronic otitis media in a tertiary referral center in Nepal. Turk Arch Otorhinolaryngol 2020; 58(4): 234-40.
5. 5. Sharma N, Jaiswal AA, Banerjee PK, Garg AK. Complications of chronic suppurative otitis media and their management:A single ınstitution 12 years experience. Indian J Otolaryngol Head Neck Surg 2015; 67(4): 353-60.
6. 6. Wanna GB, Dharamsi LM, Moss JR, Bennett ML, Thompson RC, Haynes DS. Contemporary management of ıntracranial complications of otitis media. Otol Neurotol 2010; 31(1): 111-7.
7. 7. Iyigundogdu I, Gedik E, Derle E, Kibaroglu S. Listeria rhombencephalitis and ınfratentorial brain abcesses ın a young adult with stroke like presentation. Neurol India. 2023; 71(6): 1263-5.
8. 8. Vâtă A, Irimie-Băluţă E, Roşu FM, Onofrei IM, Loghin II, Perţea M, et al. Polymicrobial bacterial meningitis in a patient with chronic suppurative otitis media: Case report and literature review. Medicina (Kaunas) 2023; 59(8): 1428.